Nurse-administered malnutrition screening tool improves access to nutrition care and malnutrition diagnoses

Malnutrition is common in hospitalized patients. Early identification and treatment can improve outcomes. The objective of the study was to determine the impacts of using a nurse-administered Malnutrition Screening Tool (MST).

This was a mixed-methods retrospective cohort study of 6163 patients admitted to a VA hospital for at least 48 h and screened for malnutrition risk from May 1, 2018, to March 1, 2020. Data was abstracted from the VA Corporate Data Warehouse (CDW) and electronic surveys were administered to staff RNs and RDNs to evaluate perceptions. Alchemer and Excel were used to collect and assess clinician survey responses and care coordination. Mann-Whitney tests assessed outcome measures of changes in time from admission to malnutrition screening, assessment, diagnosis; number of nutrition assessments completed by RDNs.

The time from admission to screening was reduced post-MST implementation [1.0 IQR (0.5, 2.4) to 14.6 IQR (9.6, 19) hours, p < 0.001]. The time to assessment increased [20.6 IQR (3.8, 29.5) to 34.1 IQR (16.6, 54.7) hours, p < 0.001], but the time to malnutrition diagnosis did not change [34.8 IQR (18.2, 47.8) vs. 28.1 IQR (17.3, 44.6) hours, p = 0.263]. The percentage of patients assessed increased from 4.8 % (164/3383) to 25.8 % (717/2780) (p < 0.001) and the percentage diagnosed with malnutrition increased from 5.3 % to 11 % (p < 0.001). Most registered nurses (RNs) felt that the MST improved quality of care, while RDNs did not. Most RNs reported that the MST was easy to use. The majority of RDNs felt their workflows improved. Both RNs and RDNs agreed that the process change improved collaboration.

MST implementation improved overall access to care. Findings from this study can be used to optimize resources to improve clinical workflows.